Have 39 BMI, sleep apnea, but denied lap band surgery

by Susanna
(New jersey)

I am in the process of trying to get lap band surgery for being overweight. My insurance company has a policy that you have to wait 90 days before you can have the surgery.

In the meantime I had to go thru a series of things. Bloodwork ...pulmenology testing...EKG ...barium swallow test...chest X-ray...psychological work up...go to a seminar...watch a tutorial... Echo cardio gram...also had to see a nutrionist for 3 months and did a sleep study test... Also had to show proof of prior weightloss attempts....after all this and 90+ days later to be told I was denied because my sleep apnea was not severe enough ...

Yet I have a BMi of 39 and considered morbidly obese. So I'm going to appeal it. My question is : can I actually have more severe sleep apnea and the reason test showed mild because I felt I never got into a good sleep like I do at home...

I was in a strange place...constantly being woken up by the tech to check leads on my leg that kept coming off during night. Then being woken up again to be told to turn over ... Because at home my husbands tells me I snore loudly and at times I have woken up gasping for air or my heart racing... How do I fight this?

Answer

Reading your story makes me MAD, thinking that insurance companies are NOT interested in their patients' best interest. Unfortunately, this situation is not uncommon.

It's a stupidity to be denied for lap band surgery just because your sleep apnea is not severe enough. By the way, how severe is your OSA now? And more importantly...how severe the OSA should be for your insurance company to accept the surgery?

To answer your question, sleep apnea will worsen over time. So the severity will increase, but the side effects will worsen as well. A sleep study will be necessary after a period of time, let's say 3 to 6 months, to diagnose correctly the severity of OSA.

However, you shouldn't avoid the CPAP (or whatever treatment you have) to worsen your sleep apnea on purpose. Your heart can suffer irreparable damage, or a stroke can cause vision and memory problems, and even paralysis.

So...please don't stop your treatment for sleep apnea.

If your coverage is denied, the best think you can do is to appeal. While it's frustrating to have your request denied, please don't give up. If the severity of your sleep apnea is the only reason for denial, then this reason can be contested during the appeal process.

However, you should be prepared to meet obstacles from the insurance company, but with perseverance you CAN succeed. A lawyer who specializes in this field can add huge support in your favor. I can recommend a lawyer, but unfortunately is too far away from New Jersey: http://www.obesitylaw.com

But it's a place to start... I'm sure you can find good lawyers in your city.

I'm also sure you will be accepted for lap band surgery. But only if you don't give up appealing.

Comments for Have 39 BMI, sleep apnea, but denied lap band surgery

i too was denied by BCBSI not once but TWICE!!! My Dr submitted all my paperwork Oct 19th and at the end of the month I got my 1st denial. I was pissed!!!

I didn't give up even when it seemed as though the staff at my drs office did. I took it upon myself to have sleep apnea test done and had them fax that paperwork in and called BCBS EVERY SINGLE DAY!!

Yesterday they sent approval letter to my dr, today I went in to sign consent and i'm scheduled for surgery ...what ever you do, DON'T GIVE UP!!! and don't rely on someone else to get necessary paperwork for you. Do it yourself, make the calls yourself and document who you spoke to..Good luck to you dear...

Feb 06, 2012Rating

Lap Band encouragementby: Susanna

Thank you Germaine for your comment. It was very helpful and as we speak I have already made another appointment with my primary dr and the pulmenologist this week. I will gather as much information I can to appeal this decision. So wish me luck!!!!